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as follows:—In residential institutions other than schools or hospitals, 11 cases; in schools, 9 cases;
in hospital wards, 10 cases; from a case previously notified in the patient's home, 8 cases; from
an unrecognised case in the patient's home, 3 cases; from a diphtheria patient discharged from
hospital, 2 cases; from sources beyond the Borough, 8 cases.
In 28 houses where diphtheria occurred the drainage system presented defects, which were
remedied in response to notices from the sanitary inspectors. For diagnostic purposes or the
detection of healthy carriers, swabbings were taken from the nose or throat of suspected persons
in 340 instances, and examined for the presence of diphtheria bacilli at the Council's expense in
the bacteriological laboratories of the Lister Institute. In 52 cases the diphtheria bacillus was
found. Anti-toxin was administered at the Council's expense to 14 diphtheria patients, to 19
persons who had been in contact with patients, and to 4 persons who were suspected to be suffering
from diphtheria, or to 37 persons in all. By a resolution passed at the meeting of the Council
on January 16th, the fee payable to practitioners for the administration of the Council's antitoxin
to contacts was reduced from 5s. to 2s. 6d., and by a further resolution passed on December 17th,
the Council's offer to supply anti-toxin and to pay fees for medical assistance in connection
therewith was limited to cases of diphtheria patients and persons suspected to be suffering from
diphtheria. Out of 180 patients notified only 8 had acquired the infection from a recognised case
of diphtheria in the same house, although the number of susceptible persons exposed to infection
at home could not well have been less than 300. This is the usual experience in any district and
in any year, and shows diphtheria to be, save in exceptional circumstances, a disease of low infective
power. It is also now recognised that untoward results have followed the administration of
anti-toxin to healthy persons, and although such results are uncommon, they contra-indicate the
promiscuous use of anti-toxin as a preventive measure against a disease to which so many
susceptible persons are exposed without becoming infected. Of the eight persons infected at
home by previously notified cases, the majority had probably acquired the disease before the
notified case had been seen by a medical practitioner. In these circumstances had some three
hundred healthy persons in contact with the 180 patients notified during' the year received
prophylactic doses of anti-toxin at a cost to the Council of £75, less than 8 persons and possibly
none would have been saved from an attack of diphtheria, and this result could not
have been achieved without some slight risk of injury to one or more of the 300 contacts, who, as
a matter of fact, escaped without any special measures being adopted.

From the figures given it will be seen that the disease has been exceedingly mild in type,
since the case fatality did not exceed three deaths per hundred cases. The number of cases
notified was 180 as compared with extremes of 125 in 1905, 234 in 1907, and the annual average
of 185 cases during the past ten years.
SCARLET FEVER.
During the year '297 cases of Scarlet Fever were notified, and of these only 5 proved fatal.
The seasonal incidence of the disease which has already been shown with that of diphtheria,
was heaviest in the months of June, July, and again in October. In the Metropolis as a whole
there was no corresponding increase in the early summer months, but the October rise was general
throughout London. Of the 46 cases notified in the four weekly period ending on July 13th,
24 occurred in the two Wards of St. Charles and Golborne, and 8 in the Ward of Holland.